ARKANSAS, DELAWARE, IOWA, NEW MEXICO, RHODE ISLAND, AND WEST VIRGINIA

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

TENNESSEE

 

Medicare Supplement Policy Forms: Plan A: AR-MSD-AA-A-TN; Plan F: AR-MSD-AA-F-TN; Plan G: AR-MSD-AA-G-TN; Plan N: AR-MSD-AA-N-TN.

 

Exclusions and Limitations

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) confinement that begins or expenses incurred while your policy is not in force.

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

WYOMING

 

Exclusions and Limitations

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible;

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first ninety (90) days from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least ninety (90) days of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a ninety (90) day waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than ninety (90) day prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days prior to the policy effective date.

ALABAMA, ARIZONA, CONNECTICUT, GEORGIA, ILLINOIS, INDIANA, KANSAS, KENTUCKY, MARYLAND, MISSISSIPPI, MISSOURI, NORTH CAROLINA, OHIO, SOUTH CAROLINA, AND SOUTH DAKOTA

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

COLORADO

 

Important Notice: In Colorado, all Medicare Supplement plans are available to persons eligible for Medicare because of disability.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benfits of this policy and the benefits paid by Medicare may not exceed one-hundred perecent(100%) of the Medicare Eligible Expenses incured. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs(except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of creditable coverage; or,if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.Evidence of prior coverage or replacement must have been disclosed on the application for this policy.If you had less than six (6) months prior creditable coverage,the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage.If this policy is replacing another Medicare Supplement policy,credit will be given for any portion of the waiting period that has been satisfied.A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

IDAHO

 

Medicare Supplement Policy Form Series: Plan A: CHLIC-MS-IA-A-ID; Plan F: CHLIC-MS-IA-F-ID; Plan High Deductible F (HDF): CHLIC-MS-IA-HDF-ID; Plan G: CHLIC-MS-IA-G-ID and Plan N: CHLIC-MS-IA-N- ID.

 

Exclusion and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible; (Not Applicable in Plans F & HDF)

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre- existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months before the effective date of coverage.

MICHIGAN

 

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-MI; Plan F: CHLIC-MS-AA-F-MI; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-MI; Plan G: CHLIC-MS-AA-G-MI; and Plan N: CHLIC-MS-AA-N-MI.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F and HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

OKLAHOMA

 

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-OK; Plan F: CHLIC-MS-AA-F-OK; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-OK; Plan G: CHLIC-MS-AA-G-OK; Plan N: CHLIC-MS-AA-N-OK.

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F and HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

PENNSYLVANIA

 

 

Medicare Supplement Policy Forms:  Plan A: CHLIC-MS-AA-A-PA; Plan B: CHLIC-MS-AA-B-PA; Plan F: CHLIC-MS-AA-F-PA; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-PA; Plan G: CHLIC-MS-AA-G-PA; and Plan N: CHLIC-MS-AA-N-PA.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible; (not applicable in Plans F & HDF)

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

 

TEXAS

 

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-TX; Plan F: CHLIC-MS-AA-F-TX; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-TX; Plan G: CHLIC-MS-AA-G-TX; and Plan N: CHLIC-MS-AA-N-TX.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

WISCONSIN

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

1) Skilled Nursing Facility Care costs beyond what is covered by Medicare and the Wisconsin mandated 30-day skilled nursing benefit;

2) Home Health Care visits above the number of visits covered by Medicare and the Wisconsin mandated 40 visits in a twelve month period;

3) Physician charges above Medicare’s approved charge, unless the Optional Medicare Part B Excess Charges Rider is purchased;

4) Outpatient prescription drugs;

5) Most care received outside the USA, unless the Optional Foreign Travel Emergency Rider is purchased;

6) Dental care (except anesthesia charges for dental care provided in a hospital or ambulatory surgery center), dentures, checkups, routine immunizations, cosmetic surgery, routine foot care, examinations for and the cost of eyeglasses or hearing aids, unless eligible by Medicare;

7) Any expense incurred in excess of the Usual and Customary Charge or not medically necessary as determined by Us for all required Wisconsin mandated benefits;

8) Any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

9) Any services that are not medically necessary as determined by Medicare;

10) Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

11) Any type of expense not a Medicare Eligible Expense except as provided previously in this policy

PREEXISTING CONDITION: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy.

If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

DEFINITION

PREEXISTING CONDITION means a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

ALASKA, DISTRICT OF COLUMBIA, HAWAII, MAINE AND VERMONT

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

NEW JERSEY

 

Medicare Supplement Policy Forms: Plan A: LY-MSD-AA-A-NJ, Plan C: LY-MSD-AA-C-NJ, Plan F: LY-MSD-AA-F-NJ, Plan G: LY-MSD-AA-G-NJ, and Plan N: LY-MSD-AA-N-NJ.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans C and F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  These policies will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy.  If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.  A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

OREGON

 

Medicare Supplement Policy Forms: Plan A: LOYAL-MS-AA-A-OR; Plan B: LOYAL-MS-AA-B-OR; Plan C: LOYAL-MS-AA-C-OR; Plan D: LOYAL-MS-AA-D-OR; Plan F: LOYAL-MS-AA-F-OR; Plan G: LOYAL-MS-AA-G-OR; and Plan N: LOYAL-MS-AA-N-OR

 

Exclusions and Limitations for Oregon Plans A, F, G & N:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  No claim for loss incurred after six (6) months from the effective date of your coverage will be reduced or denied on the ground that a disease or physical condition had existed within six (6) months prior to the policy effective date.  These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy.  If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.  A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

 

Exclusions and Limitations for Oregon Plans B, C & D:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan C)

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  No claim for loss incurred after six (6) months from the effective date of your coverage will be reduced or denied on the ground that a disease or physical condition had existed within six (6) months prior to the policy effective date. These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.